Women's Flashcards

Question

how common are miscarriages?

Answer 1

20% of recognised pregnancies will end in pregnancy loss

Answer 2

* Free B-HCG is increased in trisomy 21, whereas PAPP-A is decreased * Both free B-HCG and PAPP-A are decreased in trisomy 18 * Nuchal translucency is thicker in trisomy 21 (plus there may be an absent nasal bone and polyhydramnios)

Answer 3

1500mlU/mL on a transvaginal ultrasound

Answer 4

**"Blighted ovum"** When a gestational sac forms but no embryo develops.

Answer 5

* Stretch and sweep * Prostagladins * Oxytocin * Balloon catheter

Answer 6

5% 0.5% (most migrate)

Answer 7

* Normal * 4.2-4.8 repeat 30 mins ( pH 7.21 - 7.24) * 4.8 - 5.0 Expedite delivery ( pH * \>5.0 urgent delivery (pH

Answer 8

aka 'triple test' as it involves maternal serum screening (looking for PAPP-A and free B-HCG) + an ultrasound which looks for nuchal translucency.

Answer 9

**HELPERR** Help Evaluate for episiotomy Legs (McRoberts Manouvre) Pressure - suprapubic Enter - rotational manouvres Remove the posterior arm Roll onto hands and knees

Answer 10

1. Counselling RE adequate, ongoing contraception 2. Offer an STI screen, education if required RE barrier protection from STIs 3. Ascertain if the sex was consensual-non consensual 4. Discuss pap smears 5. Abortion if emergency contraception fails

Answer 11

**Risks of all IUDs** * Pelvic infection - first 3 weeks following insertion * Perforation of the uterus during insertion * IUD moving from its position after insertion * Ectopic pregnancy * Some intermentsural bleeding for 6 months (but then reduces by 90% and usually amennorheic) **Risks of Myrena** * Risks of progesterons (although local, so very unlikely) * Hirsuitism * Apetite increase / weight gain / acne * Irregular bleedining * Loss of libido * Mood change **Risks of Copper IUD** * Heavy bleeding

Answer 12

**HELPERR Mnemonic** **H – Call for help** * senior obstetric, midwifery and paediatric assistance * Ask patient to stop pushing * Move patient into position to facilitate manoeuves: flat on back/bottom of bed **E – Evaluate for episiotomy** * should be considered to make room for rotation maneouvres * episiotomy alone will **not** release the shoulder * aids in access for internal manoevres **L – Legs ( McRoberts maneouver)** * Flexing and abducting the maternal hips, positioning the maternal thighs up into the maternal abdomen * This flattens the sacral promontory and results in a cephalad rotation of the pubic symphysis **P – Suprapubic pressure** * Assistant hand should be placed suprapubically over the fetal anterior shoulder, applying pressure in a CPR style in a downwards motion * Aims to decrease the fetal bisacromial diameter or rotate fetus into oblique plane **E – Enter maneuvers ( internal rotation)** * Attempting to rotate the anterior shoulder into an oblique plane and under the maternal symphysis **R – Remove the posterior arm** * Apply pressure to the antecubital fossa to flex the elbow in front of the body and grasp the posterior hand to sweep the arm across the chest and deliver the arm * Rotate fetus into oblique plane and deliver **R – Roll the patient** * Rolling onto all-fours may dislodge the shoulder. * Opens pelvis in A-P plane * Apply gentle downward traction to disimpact posterior shoulder from sacral promontory

Answer 13

Morphology scan --\> head to toe check for anatomical abnormalities Growth (4 measurements) Locates the placenta (5% of women will have a low lying placenta) Amniotic fluid volume **_May_** also perform umbilical artery doppler and/or cervical length if indicated

Answer 14

**BITCHFACE** ## Footnote B – Bleeding disorder I – Iatrogenic (IUDs and drugs) T – Thyroid dysfunction (especially hypo) C – Cancer (Endometrial, cervical) H – Hyperplasia F – Fibroids and polyps A – Adenomyosis and endometriosis C – Chlamydia, gonorrhea and STIs E – Ectopics and miscarriage

Answer 15

***accreta*** - abnormal adherence of the placenta to the uterine wall ***increta*** - occurs when the placenta invades deeply in to the myometrium ***pancreta*** - when the placenta invates through the uterus to reach the serosa These are dangerous because they mean that the placenta can't be fully delivered, so the uterus cannot contrcat down enough to cause cessation of bleeding (therefore increased risk of PPH). They are diagnosed cliically, in the third stage of labour! Usually you check the placenta to see if it is complete, and it isn't.

Answer 16

**Intro / HOPC Definition** * What is the OCP? * How does it work? **Indications: General and Specific** * Contraception * Acne * Dysmennorhea * Menorrhagia * Endometriosis **Experience of the patient: pre, during and post** * Start the pill - preferably on day 1-5 of menstural cycle * Can start at another time if it is certain the woman is not pregnant * Need to take the pill for seven days before it will be efficious. Use condoms for these seven days and consider the use of EC if have unprotected sex until then * If miss one pill, retake is as soon as you remember * If it is missed but retaken within 24 hours, can continue sexual practises as normal * If missed but retaken after 24 hours, use condoms or abstain from sex until have taken 7 active pills in a row**.** Consider EC if have unprotected sex. * If miss three or more pills, use condoms or abstain from sex for the next seven days. If have unprtected sex, use EC. * If you miss pills in the last week and need to take seven active ones, skip the inactive ones so you can take seven in a row * If you become unwell with diarrhoea or vomitting, also take seven pills in a row * Consult with your doctor if you start on ABx or Anti-epilepsy medication **Benefit** * see indications **Risk** * Oestrogen: * Mastalgia * Nausea * Fluid retention * Abdominal bloating * Headaches * Chloasma * Progesterone * Hirsuitism * Apetite changes / weight gain, Acne * Irregular bleeding * Loss of libido * Mood changes **Contraindications** * Headache / Hypertension * Obesity * Medication (ABx, anti-convulsants) * Embolsim / Thrombus / FHx of thrombophillia * Stroke * IHD * Caner - breast / endometrial? * Kids / Breast feeding * Liver disease * Gillick competenet? **Alternatives** * Irreversible * Reversible * Long acting * implanon * depot provera * IUD - copper or hormonal * Short Acting * Mini-Pill * Other formulations of COCP **Conclusion: Check understanding, offer written information, gain informed consent**

Answer 17

* Tenderness on bimanual examination * Tenderness or nodularity on the posterior vaginal fornix * Uterosacral ligament tenderness or nodularity * Cystic ovarian enlargement * Fixation of adnexal structures * Retroflexed uterus * Episotomy or cesarean section scar implants

Answer 18

**Basics** * Health of Mother * Vital signs * Abdominal examination * FBE / CRP * Health of Baby * SAM BLACK * DO NOT DO PV EXAMS **Place and person** Depends on definitive Mx **Ix and confirm diagnosis** * Confirm gestational age (are they definitely term?) * Confirm not in labour with CTG * Sterile speculum exam to assess for liquour * Collect MCS swabs for chlamydia and gonorrheoa * Collect swab for GBS * If unsure: * Nitrazine paper test * Amnisure * Fern test **Definitive** Give antenatal steroids Give erythromycin (reduces neonatal lung dz, cerebral haemorrhage and death) Expectant vs active management **Long term** * Monitor until labour * Indication for CTG during labour * Paediatric review after birth

Answer 19

Heterotopic pregnancy when two eggs are fertilized; one implants at an intra-uterine site, another at an extra-uterine site. Often associated with induced ovulation (IVF) (1:11,000). Otherwise rare (1:40,000)

Answer 20

Removal of fallopian tube. In a ruptured / bleeding ectopic pregnancy.

Answer 21

Primigravids: up to 20 hours Multiparas: up to 14 hours

Answer 22

Can be heard in 80% of cases at 12 weeks, 90% at 13 weeks

Answer 23

1. Trisomy 21 (Downs Syndrome) and Trisomy 18 (Edwards Syndrome) 2. As above + neural tube defects - however the 20 week ultrasound is more reliable for this, anyway

Answer 24

* 4-6x risk of maternal death as compared to NVD * Haemorrhage * Injury to surrounding structures such as bowel, bladder, blood vessels, nerves and ureters * Postoperative * Thromboembolic events * Pain * Prolonged hospitalisation * Postop infection involving the urterus, wound, bladder, lung and IV site

Answer 25

* Pain * Perineum * Pissing * Pooing * PPH * PreEclampsia / GDM * PE / DVT * Pyrexia (mastitis, endometritis) * Psych * Protection

Answer 26

75g 2 hour POGTTWomen should fast overnight.They should then have a fasting BSL, and then a BSL at one and two hours.It is not uncommon for women to vomit during this test, before the two hour mark. If this is the case, you can still consider the 1h result but it is best to do an HbA1c too

Answer 27

LNG Yupze Method (although less effective than levonorgesterl) Copper IUD RU486

Answer 28

* Hypertonic uterine contractions that do not lead to effective cervical dilatation * Hypotonic uterine contractions * Premature or excessive use of sedatives or analgesics

Answer 29

* Single dose of 50mg/m2 of IM methotrexate. * B-HCG levels are checked on day 4 and 7, and should fall by 15%. If not, give a second dose. * 15% of women will need a second dose. 7% will need subsequent surgery.

Answer 30

* Increased miscarriage risk * High risk of DKA due to the increased insulin resistance and therefore increased fat break down * Hypoglycaemia may also occur periodically especially in early pregnancy when nausea and vomiting interfere with caloric intake * 2 fold increased risk of pre-eclampsia * Diabetic retinopathy and diabetic nephropathy both worsen with pregnancy

Answer 31

It is a prostaglandin E1 analogue --\> causes strong uterine contractions

Answer 32

No. In fact it might be dangerous. Only short term tocolysis is indicated; for the purposes of finishing a course of antenatal steroids or for transfer to facility with NICU

Answer 33

In women without a previous Hx of miscarriage, once the foetal heart is detected, the risk of miscarriage is 2%. This statistic is 18% for women with a Hx of miscarriage.

Answer 34

* For these patients, management ideally begins before conception, with the goal of optimal glucose control before and during pregnancy * Insulin requirements will increase during pregnancy, most markedly between 28 and 32 weeks of gestation * Patients may need to be seen every 1 to 2 weeks during the first two trimesters, and weekly afterwards * Post Partum - immediately reduce dose to pre-pregnancy doses as there is a rapid loss of insulin resistance post delivery

Answer 35

Progesterone antagonsist. Used to "prime" the uterus before misoprostol. Causes the embryo to detach and ripens the cervix.

Answer 36

* * consider termination OR expectant management * 24-34 weeks gestation * expectant management (unless complication for foetus or mother) * 34 weeks gestation * active management

Answer 37

**Causes** 1. Tone (uterine atony) 2. Tissue (retained products) 3. Trauma 4. Thrombin (DIC, coagulopathy) **Risk factors** * Tone (uterine atony) * prolonged/dysfunctional labour * polyhydramnios * macrosomia * fibroids * intrauterine infection * MgSO4, general anaesthetic, tocolytics * Tissue (retained products) * abnormal placenta * Trauma * operative or instrumental delivery * Thrombin (DIC, coagulopathy) * HELLP/pre-eclampsia * Family or personal history of bleeding disorder

Answer 38

episiotomy

Answer 39

Copper IUD Mifepristone RU486

Answer 40

***_Medical Management_*** **First insert a catheter and massage the uterus to stimulate contractions.** ***1st Line:*** Ergometrine Syntometrine (ergometrine + syntocinon) ***2nd Line:*** IV syntocin infusion ***3rd Line:*** Misoprostol Prostaglandin F2α ***_Surgical Management_*** If medical management is unsuccessful. * Without laparotomy * Examination under anaesthetic – allows for more thorough search for lacerations and retained products * Prostaglandin F2α injection into uterus from abdomen * Backri balloon – inflated within uterus to provide tamponade * With lapartomy * Manual pressure on uterus * B lynch suture – a suture generated clamping of the uterus that may preserve future fertility * Bilateral uterine artery ligation and internal iliac artery ligation * Last line - hysterectomy

Answer 41

Non Invasive Perinatal Screening (NIPS) aka "percept" A blood test looking at foetal cells in the maternal circulation Newer test - expensive (over $400 AUD)

Answer 42

* In or on the ovaries * Posterior cul-de-sacc * Uterosacral ligaments * Broad ligament * Anterior cul-de-sac

Answer 43

* Pelvic pain * Secondary dysmenorrhea * Deep dyspareunia * Low sacral backache * Diffuse pelvic pain * Disease severity does not predict the degree of pain * Infertility

Answer 44

* Maternal/fetal * Dystocia * Cephaloelvic disproportion * Maternal * Maternal disease * Eclampsia/severe preeclampsia * Diabtes * Cervical cancer * Active herpetic outbreak * Ovarian tumour * Previous uterine surgery * Obstruction in birth canal * Fibroids * Fetal * Fetal distress * Cord prolapse * Fetal malpresentation * Macrosomia * Higher order multiple gestation

Answer 45

* FBE * Blood group and antibodies * Consider cross-match is patient is likely to need a transfusion * B-HCG - may consider serial B-HCG * U/S - transvaginal vs abdominal * urine test or high vaginal swab for chlamydia in women

Answer 46

* Nulliparity * Infertility * Reproductive age (usually late teens to forties) * A first-degree relative with endometriosis * Regular menstrual cycle * Prolonged menses of 8 or more days

Answer 47

* Multiple gestation * Gestational trophoblastic disease * Triploidy * Trisomy 21 * Hydrops fetalis * H pylori

Answer 48

* Severe comprompse -\> -\>DELIVERY * Fetal bleeding disorders suspected * Face presentation * Maternal Infection eg hepatitis, HIV

Answer 49

5.5 weeks gestation detection of heart beat also rules out non-viable pregnancy

Answer 50

Metabolic syndromeOsteoporosisVaginitis

Answer 51

* Soft cheeses * Precooked/ pre-prepared cold foods not to be reheated eg. Salads, deli meals * Undercooked meat, chilled pre-cooked meats, pate, meat spread * Raw seafood * Unpasteurised foods * Pre-prepared/ packaged cut fruit and vegetables * Soft serve ice cream

Answer 52

* Early Decelerations * Decrease in HR with slow onset early in the contraction and return to baseline by the end of a contraction * Usually a normal finding * Indicative of head compression * Variable decelerations * V shaped due to rapid onset and recovery * Drop of \>15bpm for \>15secs * Are considered non-reassuring * Late decelerations * A uniform repetitive decreasing of foetal HR with an onset mid to end of the contraction and ends after the cessation of the contraction * Indicates uteroplacental insufficiency * Prolonged decelerations * Decrease \>15bpm for \>90secs but * Can indicate maternal hypotension or hyperstimulation * Complicated variable decelerations

Answer 53

Dyspareunia

Answer 54

1. placenta previa 2. placental abruption 3. vasa previa

Answer 55

* Ineffective uterine expulsive forces * Abnormal presentation, position or foetal structure * Disproportion between the size of the foetus and the maternal pelvis * Obstruction of the birth canal

Answer 56

1. *maternal blood pressure -* Gestational HT (increased blood volume, no drop in perippheral vascular resitance due to uterine artery dilation) 2. *endothelial dysfunction of* *materal kidneys -* Pre-eclampsia (proteinuria, oedema) 3. *endothelial dysfunction of* *maternal liver -* HELLP syndrome 4. *endothelial dysfunction of maternal brain* - liver **5. placental abruption** **6. IUGR**

Answer 57

SARaH Syphillus Asymptomatic bacturia Rubella and HIV & Hepatitis B Group B Strep is recommended to all women at week 37

Answer 58

spontaneous pregnancy loss before five weeks gestation (so called because B-HCG is elevated but a gestational sac cannot be viewed on ultrasound) When a gesttaional sac can be viewed on ultrasound, this is called a clinical pregnency (not really the opposite - because this is a viable pregnancy)

Answer 59

* Candidates must: * Be haemodynamically stable * Have minimal symptoms * Have an initial B-HCG * Have a U/S confirmed ectopic pregnancy * Be available for twice weekly B-HCG and weekly transvaginal U/S * Be informed of the risk of tubal rupture, haemorrhage and emergency surgery

Answer 60

The time from the onset of cycle irregularity through until 12 months after the menstrual period.

Answer 61

* A sign of shoulder dystocia * The head appears to be pulled back by the perineum - the vulva remains tightly applied to the head

Answer 62

spontaenous loss of pregnancy before 20 weeks

Answer 63

A small SFH could represent * FGR * Oligohydramnios A large SFH could represent * Macrosomia * Multiple pregnancy (rarely missed on ultrasound) * Polyhydramnios

Answer 64

In Australia, all pregnant women should be screened for GDM between 26 and 28 weeks gestation. The recommended screening regimen is a **_75 gram two-hour Pregnancy Oral Glucose Tolerance Test (POGTT)_.** * Fasting test- fast from 2200 * Fasting blood sugar (drink 75gm glucose load) **_Diagnostic criteria_** **_2 hour OGTT_** * Normal * GDM = 8.5-11.0 * DM in pregnancy \>11 Notes – when normally diagnosing DM (not gestational), can’t use 1h GTT. But can in GDM.

Answer 65

MOTHER AND PIG Medical issues (heart dz, chronic renal dz, auto-immune) Obstetric cholestasis (controversial) Too long! (\>41 weeks) Haematological (Rh isoimmunisation) / Hypertension (preeclampsia, eclampsia) Endocrine (GDM) – at 38-39 weeks (due to foetal macrosomia) ROM early / Request (maternal psychosocial issues) Planned neonatal surgery In Utero Demise (IUD) or Intrauterine death Growth restriction

Answer 66

14 - 20 weeks

Answer 67

CV risk factors (HT, DM, hyperlipidaemia) Trauma Sudden uterine decompression - following ROM or delivery of the first twin Chorionamnitis

Answer 68

* Abscesses will require aspiration * eTG recommends flucloxacillin * Analgesia * Cold lettuce leaves are a common, anecdotal therapy for pain relief

Answer 69

HOTFLUSH ## Footnote H – heart disease risk increased O - osteoporosis T – tired, teary and Thrombus risk (if HRT) F – Friction (atrophic vaginitis) L – Libido change U – Urinary S – Strange cycles H - Headaches

Answer 70

high dose progesterone (Etonogestrel) it is 99.95% effective 1/3 of women experience amenorrhea, 1/3 experience light bleeding and 1/3 experience heacy bleeding (consider removal) it can stay in for 3 years you should perform a B-HCG prior to insertion

Answer 71

No longer than 8 hours in multiparous women No longer than 12 hours in nulliparous women

Answer 72

Contraception Acne Dysmenorrhea Menorrhagia Endometriosis

Answer 73

**History** * Has the patient receive syntocinon (should try first) * How long has the labour been? * What is the mother’s BMI? Baby’s estimated weight? * Gestational diabetes? * Osteogenesis imperfecta (absolute contraindication) **Examination** * Palpate abdomen for foetal size and engagement * Perform VE --\> is the head at or below spines? * Is there a ‘face’ presentation? FORCEPS

Answer 74

**Intra-uterine causes** * Fibroids * Infection * Retained products **Extra-uterine causes** * Full bladder * Full rectum * Broad ligament haematoma

Answer 75

The Ten P’s of Early Post-Partum * Pain * PE/DVT * Perineum * Pyrexia (WWWWWWs or intrauterine infection or mastitis) * Pulse (PPH?) * Pre-eclampsia * Pooing - should resume in 3 days * Pissing * Psyche * Protection

Answer 76

Expectant OR Medical OR Surgical

Answer 77

**TEN ELEVEN** ## Footnote Term Engaged (cephalic presentation) No VE or cervical sutures EFM (CTG) normal Logistics for ongoing Evaluatiuon Vitals normal Exit Portal should have No GBS

Answer 78

The chorion is the placenta The amnion is the fluid sack of foetal urine

Answer 79

Pelvic pain which is worse prior to menses and is eased with menses (secondary dysmenorhea). May also have subfertility, dyspareunia, rectal bleeding (endometrial tissue in colon) or haematuria (endometrial tissue in urinary tract). Examination is usually unremarkable.

Answer 80

12-13 / 40

Answer 81

Remember: **ABCEIOU** (see summary) Breast cancer DVT / PE Stroke Endometrial cancer Cholecystitis

Answer 82

**_Basics_** * ****Anti-D for rhesus negative women **_Place and Person_** **_Investigate & Confirm Diagnosis_** * Confirm non-viable intra-uterine pregnancy with B-HCG or ultrasound * High vaginal swab / serology for chlamydia if opting for surgical management * Culture of genital discharge to screen for gonhorrea prior to surgical management * Vaginal swab for bacterial vaginosis prior to surgical management **_Definitive Management_** * Medical or surgical management **_Prophylaxis / Ongoing Rx_** * Psychological support * Contraceptive advice - all hormonal and implantable methods of contraceotion can be performed at the time of D&C

Answer 83

***Complete miscarriage***: The uterus is empty - all of the products of conception have been expelled. The cervix is closed. Symptoms have often resolved. ***Incomplete miscarriage***: some products of conception have been expelled, but not all.

Answer 84

Galactagogues Domperidone (Motilium) and Metaclopromide (Maxalon)

Answer 85

***The 10 Ps*** Periods: * First period (age of mecarche) * Regularity * Volume * Last normal menstrual period / age of menopause Pain (with periods, sex or other times) Partners + sexual activity * Number of partners * Sex of partners * Type of relations Protection * Contraception * Screen for Domestic Violence Parents (maternal menopause) Pissing/pooing? * Dysuria * Nocturia * Polyuria * Urgency * Incontinence Pap smears and breast checks PCOS Pelvic inflammatory disease * Vaginal discharge? (colour, quantity, odour) Pregnancy

Answer 86

* Engagement (usually before the true onset of labour) * Descent * Flexion * Internal rotation * Extension * Restitiution and external rotation

Answer 87

The cervix should dilate \>1cm per hour of labour. In multigravidas, this figure is probably closer to \>2cm.

Answer 88

Macrosomia (BW = \>2500g) Instrumental delivery

Answer 89

* Within 5 to 10 minutes of the end of the second stage?

Answer 90

Dilatation and suction curettage

Answer 91

PATH and ROAD? Prolapsed umbilical cord Abruption of placenta Tachysystole / Hyperstimulation Hyponatraemia & Haemorrhage Rupture of uterus Oedema / fluid retention Atonic uterus Didn’t work (failure of induction) à then need CS / operative vaginal delivery

Answer 92

**Fully Diated Cervix** Fully dilated cervix OA position (ideal) Ruptured membranes Contractions/catheter Episiotomy and epidural Presentation: cephalic Station: Spines or below (0 or

Answer 93

**VBAC** * Grade 1: Skin of **v**agina torn * Grade 2: Involves perineal (**b**ulbocavernosus) muscle * Grade 3: To the **a**nal sphincters * A) * B) \>50% of external sphincter * C) Internal sphincter * Grade 4: Tear to anal **c**anal

Answer 94

Unfavourable cervix. Most likely PGE2 or transcervical catheter (the latter if VBAC)

Answer 95

**Basics** * Health of mother * Vitals * Abdominal examination * FBE / CRP * Health of baby * SAM BLACK * Symphysiofundal height * Auscultate foetal heart * Ask RE foetal movements * Biophysical profile * Lengths on US * Amniotic fluid index * CTG * Kinks in U/S **Place and Person** **Investigate and confirm diagnosis** * Confirm gestation * CTG - ensure they're not in labour * sterile speculum examination * DO NOT PERFORM VAGINAL EXAM **Definitive Management** * Expectant versus Active Management * Don't forget to consider GBS status before inducing labour **Ongoing management** * CTG during labour * Paediatric review after birth?

Answer 96

A spectrum of placental tumours that arise from genetically abnormal embryos. GTD may be benign (most commonly) or rarely malignant.

Answer 97

Normal = a CTG trace where all four features are rated as reassuring. Suspicious = a CTG trace where one feature falls into the non-reassuring category. Pathological = when two or more features fall into the non-reassuring category, or one feature falls into the abnormal category.

Answer 98

PATCH ## Footnote P – Polyps (cervical, endometrial) A – Atrophic vaginitis (80%) T – Therapy (cyclical HRT or HRT withdrawal) C – Cancer (cervical, endometrial, rarely ovarian) H – Hyperplasia (typical or atypical)

Answer 99

A miscarriage complicated by infection – can lead to PID, sepsis and death

Answer 100

1. Continuous Use - oestrogen and progesterone both daily. Have to have had cessation of period for one year or greater before commencing. 2. Cyclycal Use - oestrogen daily and progesterone for 10-14 days of teh cycle. May have withdrawl bleed upon cessation of progesterone.

Answer 101

Two doses of 12 mg IM betamethasone, given 24 hours apart OR Four doses of 6mg IM dexamethasone, given 12 hours apart

Answer 102

* Nulliparity * Precipitous labour ( * Birth weight \>4kg * Occipito-posterior position * Shoulder dystocia * Induction of labour * Epidural analgesia * Assisted delivery (forceps)

Answer 103

GDM --\> hyperglycaemia --\> increased release of insulin and insulin like growth factor from the foetus --\> hepatomegaly and increased growth

Answer 104

"DR C BRAVADO" * Determine risk * Contractions * Baseline * Must be taken with the absence of foetal movements or uterine contractions * Normal 110-160 * Variability * May not be present when foetus is sleeping * 5-25bpm * Accelerations * \>15bpm for \>15secs * Decelerations * Typically \>15bpm for \>15secs * Overall assessment

Answer 105

Maternal * PPH (most common) * Rectovaginal fistula * Pubic symphysis separation * Episiotomy /tear * Uterine rupture Fetal * Brachial plexus palsy ( common) * Clavicle # * Fetal hypoxia/death * Humeral #

Answer 106

1. amenorrhea 2. irregular bleeding 3. lower abdominal pain if more severe: 1. hypotension 2. tacchycardia 3. shoulder tip pain

Answer 107

1. Tone (uterine atony) 2. Trauma (uterine rupture, laceration) 3. Tissue (retained products) 4. Thrombin (coagulopathy)

Answer 108

**Advantages** * Mum * Planned * No tears * Less risky than emergency Caesarean **Disadvantages** * Mum * Anesthesia * Catheter + UTIs * Surgery * Bleeding, infection, DVT/PE * Adhesions * Hysterectomy * Baby * Possible TTN and need for special care (1%) * Delayed to time with mum

Answer 109

Tests for chlamydia Pregnancy test

Answer 110

A clinical diagnosis. If a woman is \> 45 years old and had been amenorrheic for 12 months you can diagnose menopause. You don't need to perform any investiagtions (althugh if you did they would have low oestrogen, AMH and inhibin and a high FSH.

Answer 111

No longer than 30 minutes

Answer 112

How to collect a 'first pass urine' specimen for chlamydia testing * This test works best if you haven't been to the toilet to pass urine in the past hour. If it is less than 1 hour since you passed urine, this test may not be accurate. Let your doctor know if this is the case * You do not need to clean or wipe yourself before this test * You need to collect the very first part of your urine stream. This means first passing urine straight into the container, not into the toilet * Once the container is about a quarter full, pass the rest of your urine into the toilet

Answer 113

* Preterm breech fetus or in any preterm delivery with under deceloped lower uterine segment * Fetus in a transverse lie with back down * Restricted access to the lower uterine segment secondary to fibroids or dense adhesions * When a hysterectomy is to follow the delivery of the fetus * Presence of an invasive cervical cancer * Postmortum C/S to remove a live fetus

Answer 114

**Advantages** * Mum * Shorter hospital stay * Less analgesia required * Often felt to be ‘more satisifying’ * Baby * Less likely to have TTN * More easily cared for by mum, who is physically well sooner **Disadvantages** * Mum * Instrumental birth * Bleeding * Tears * Emergency Caesarean (30%) * Hysterectomy (rare, PPH) * Rupture of scar (1 in a 100)

Answer 115

Lifestyle Modifications * Cut down smoking * Healthy diet + exercise to reduce BMI * Cut down ETOH * Dress in layers * Carry a small fan Complementary * Phyto-oestrogens (soy isoflavones, black coshosh) Non-Hormonal * For vasomotor symptoms - SSRI, SNRI, gabapentin * For urogenital symptoms - cranberry juice, lubricants Hormonal * HRT

Answer 116

Gold standard = laparoscopyCan also perform U/S or MRI.

Answer 117

amniorrhexis

Answer 118

after 5 weeks

Answer 119

* Persistent vomiting * Volume depletion * Ketosis * Electrolyte disturbances * Weight loss

Answer 120

***Threatened miscarriage*** - bleeding in the first 20 weeks of gestation (a presentation, not a diagnosis). ***Missed miscarriage -*** In this situation what happens is that the embryo fails to develop fully and, instead of being passed out of the womb in a miscarriage situation, it is retained inside. ie. "*_asymptomatic fetal demise_*". Diagnosed retrospectively on U/S because the fetus is too small for gestational age, reflecting cessation of growth at an early gestation e.g. absence of fetal heart and 9 week sized foetus on 12 week U/S

Answer 121

- placenta previa and abruption - maternal blood loss - vasa previa - foetal blood loss

Answer 122

* 1st degree: involves the vaginal mucosa or perineal skin * 2nd degree: extends intot he submucosal tissue of the vagina or perineum with or without involvement of the muscles of the perineal body * 3rd degree: involves the anal sphincter * 4th degree: involves the rectal mucosa

Answer 123

* That they may experience light bleeding for a few weels * That they should abstain from sexual intercourse and avoid using tampons for a few weeks, to reduce the risk of infection * That their period may not occur at the usual time, because the uterus has to build new lining

Answer 124

1-3% 50% within 24 hours, 80% within 7 days

Answer 125

\>6 hours post

Answer 126

In one series, patients recovered on average in 24 days No treatment required Beware the eye! Tape and protective gel can be used

Answer 127

***Primary*** •Occurs in the first 24 hours after delivery ***Secondary*** •Occurs after 24hrs and before 6 weeks after pregnancy (end of post-partum period)

Answer 128

* Confirm gestation * Confirm that they are definitely not in labour - CTG * Perform a **sterile speculum examination** (NOT a vaginal exam) * Look for liqour in the posterior fornix - can ask woman to cough to see it trickle down * If unsure, can do: * Nitrazine * Amnisure * Fern test

Answer 129

In term PROM you can jump straight to oxytocin. In pre-term PROM use *Modified bishop score* **"Favourable Cervix" with Modified Bishop Score \>8** IOL likely to be successful ARM +/- oxytocin infusion **"Unfavourable Cervix" with a Modified Bishop Score of 8 or less (this number varies between sources!)** Cervix needs ripening Use prostaglandin The Bishop’s Score is a clinical tool used to gauge the favourability of the cervix for labour and induction of labour. Six is a commonly used cut off. The most important component ins the dilation of the cervix. Dilation

Answer 130

**DDx** May indicate infection (endometritis) or retained products **Management** _Endometritis_ Oral Augmentin and Azithromycin (mild) IV amoxy, gent and metro (severe) _Retained products_ Evacuation + antibiotics

Answer 131

Locally secretes a high dose of progesterone: 1. makes the mucous thicker - a barrier to sperm entry 2. thins the endometrium so the egg can't implant 3. the mirena itself acts as a barrier to sperm

Answer 132

1/200 (half of that of CVS)

Answer 133

every 3 months

Answer 134

occurs in 1-3% of all pregnancies

Answer 135

TFTs (if not done already).They should have a repeat 75g OGTT 6-12 weeks post pregnancy (using non-pregnant parameters).If they have had GDM they are at an increased risk of developing TIIDM in the future so they should have ongoing monitoring every 2-3 years.

Answer 136

maternal infection foetal infection cord prolapse placental abruption

Answer 137

10-14 weeks

Answer 138

It occurs in 10% of all pregnancies

Answer 139

VBAC (pronounced veeback) stands for vaginal birth after caesarean section. The major risk if uterine rupture at the site of the previous LUCS scar - affects 1 in 200 women trying for a VBAC.

Answer 140

From delivery to 6 weeks After the puerperium any maternal complications of pregnancy (like GDM or gestational HTN) should have resolved. If they haven't treat like normal DM/HTN.

Answer 141

* 60% have ongoing pregnancy * 30% have early pregnancy loss * 9.5% have ectopic pregnancy * 0.5% other What is the other 0.5%?

Answer 142

Around week 37 progesterone levels start to drop, but oestrogen levels remain high. This higher ratio of oestrogen to progesterone causes the uterus to be more sensitive to other hormones (notably oxytocin released from the anterior pituitary) which stimulate contractions. This effect can cause some women to experience some weak contractions in late pregnancy, either called "false labour contractions" or "Braxton-Hicks contractions".

Answer 143

**Basics** * Health of Mother * Vital signs * Abdominal examination) * FBE / CRP * Health of Baby * SAM BLACK * *DO NOT DO PV EXAMS* **Place and person** Depends on definitive Mx **Ix and confirm diagnosis** * Confirm gestational age (are they definitely term?) * Confirm not in labour with CTG * Sterile speculum exam to assess for liquour * If unsure: * Nitrazine paper test * Amnisure * Fern test **Definitive** Expectant vs active management **Long term** * Monitor until labour * Indication for CTG during labour * Paediatric review after birth

Answer 144

Trisomy 21 - Increased B-HCG and inhibin, reduced estriol and AFP Trisomy 18 - reduced all of them NTDs - increased AFP

Answer 145

***_CRAM_*** **Clinical Assessment** Mother * vitals * peripheral signs of shock * abdominal examination * ask her blood group * when she had her last meal (readiness for surgery) * previous surgeries involving GA - women with placental abruption may have DIC, epidural is contraindicated in DIC and so these women will need a GA Baby * Choose some of SAM BLACK **Recussitation (if mother is unstable)** * Airway * Breathing * Circulation - 2 x wide bore canulae * Take blood off for group and hold / cross-match * Anti-D if rhesus negative **Assess for underlying cause of APH** * FBE * Coags including fibrinogen (DIC is a complication of placental abruption) * Kleihaur Test if to assess for extent of fetomaternal haemorrhage if rhesus negative * Transvaginal U/S in non-emergent cases **Management** * Consider risks versus benefit of expedited delivery versus premature delivery

Answer 146

* Uterine hyperstimulation * Powerful contractions may distress foetus (use intrapartum CTG) * Especially concerned if baby is IUGR * Can also lead to placental abruption * Hyponatraemia (ADH-activity) * Hypotension * Nausea/Vomiting * (Rarely) arrythmias and anaphactoid reactions

Answer 147

Everyone! (The guidelines used to say only those with risk factors).Between 26-28 weeks but on the first antenatal visit if they have risk factors.

Answer 148

Favourable cervix Most likely AROM + syntocin

Answer 149

A triad of consequences of oligohydramnios (regardless of the cause) Clubbed feet Pulmonary hypoplasia Cranial anomalies

Answer 150

Nucleic acid amplification test (NAAT) most commonly by PCR

Answer 151

* FBE * Blood group and red cell antibodies * MSU for asmptomatic bacteriuria * Rubella serology * Hep B serology * HIV screen * Syphilis screen * Haemoglobin studies

Answer 152

15/40 or later

Answer 153

Non-stress test Gross body movements Foetal breathing Muscle tone Amniotic fluid index

Answer 154

Contractions that occur with variable frequency and do not cause progressive cervical dilatation and effacement, can begin as early as the second trimester

Answer 155

laparoscopy (preferred) laparotomy (required in an emergency) Monitor B-HCG afterward - it should fall rapidly. If it is \>65% of original level 48 hours post op OR \> 10% of original level 10 days post op --\> think: persistent trophoblast

Answer 156

***_Mifepristone_*** (RU486) - Mifepristone acts to block the hormone progesterone --\> starves the embryo of nourishment. Also causes softening and opening of the cervix (an oral medication). ***_Misoprostol_***: This is a prostaglandin E1 analogue which causes strong uterine contractions in an attempt to expel the embryo from the woman’s body. It is taken 24-48 hours following the mifepristone (can be oral or vaginal)

Answer 157

1. pap semar normal and up to date 2. chlamydia screen negative 3. B HCG negative Can be left in for 5 years Yes, it can be used but usually requires insertion by specialist in Australia

Answer 158

* hypovolaemic shock * DIC (occurs in up to 35% of cases - as thromboplastims are released from damaged placental tissue) * Pre-renal renal failure * PPH (poor myometrial contraction following placental abruption) * Fetomaternal haemorrhage

Answer 159

Does the patient have: * A history of preterm birth? * A history of cystitis or pyelonephritis? * A known multiple gestation? * A known placenta previa? * A known fetal anomaly? * A known uterine anomaly? * Good fetal movements? * Untreated infections? * Cigarette or cocaine use? * An accurate last menstural period LMP or dating ultrasound?

Answer 160

iodine (iFolic is a good option) The developed world is becoming more iodine deficient and there is increased iodine requirements in pregnnancy due to increased thyroid activity

Answer 161

Face presentation Bleeding from scalp Delivery before 34 weeks

Answer 162

**Risks** Cord prolapse Ascending infection Failure à may not trigger good labour **Benefits** Shortens labour Reduces rate of dystocias Enables fetal scalp sampling and electrodes

Answer 163

* Collect cervico-vaginal swabs for microscopy and culture (Chlamydia trachomatis and Neisseria gonorrhoeae) * Collect low vaginal and ano-rectal swabs for GBS

Answer 164

Incomplete miscarriage. This process can take several weeks (75% success rate at 6 weeks) This option is usually only made available to women in the 1st trimester.

Answer 165

When the cervix has dilated, but products of conception are still intra-uterine. An inevitable miscarriage will either progress to an incomplete or a complete miscarriage.

Answer 166

1. Find the fundus - may not at the midline 2. With a tape which is not elastic, lay it face down and run it to the top of the pubic symphasis 3. Turn the tape over and record the measurement to the nearest 0.5 4. Roughly - gestational age in weeks = SFH +/- 2cm - should be plotted on chart

Answer 167

PGE2 Transcervical catheter Stretch and sweep

Answer 168

ABCDEFGH ## Footnote Allergy and atopy reduced Bones (protective against OP) Close relationship & contraception Developmental / IQ benefits Economical Figure: quicker return to pre-pregnancy weight GIT (NEC, IBD and gastroenteritis) Haemorrharge (post partum) reduced

Answer 169

Estimated Due date = first day of LNMP + 1 year-3months-7 days (for a 28 day cycle)

Answer 170

**Early** --\> Normal **Variable** --\> (rapid onset, variable offset, usually a/w contractions) --\> cord compression. If overall trace is good don't worry, if overall trace is bad then worry **Late** --\> (starts in middle of contraction) uteroplacental insufficiency. **_Be hesitant to call a late decel in the absence of other concerning features._** **Prolonged** --\> (15 bpm decel for longer than 90 seconds but less than 5 minutes). uteroplacental insufficiency, urgent Mx may be required. Often caused by prolonged contractions, maternal hypotension or hyperstimulation **Sinusoidal pattern** --\> Suggests severe hypoxia. Urgent C/S. Outcome is poor

Answer 171

**MOTHER PIG** Maternal medical issues (heart/renal/autoimmune dz) Obstetric cholestasis Too long (\>41 weeks) Haematological/hypertension (pre-eclampsia) Endocrine (GDM --\> macrosomia) ROM early or Request Planned neonatal surgery Intrauterine death Growth restriction

Answer 172

Exertion of traction on the umbilical cord with one hand while the uterus is lifted out of the pelvis by suprapubic pressure on the uterus with the other hand: pressure on the uterus is stopped as the placenta passes through the introitus

Answer 173

FBE U&Es High vaginal swab Pelvic ultrasound for retained products

Answer 174

From 25 weeks. Symphysiofundal height may be the GA+/-2cm The measurement **should start from the** **variable point; the fundus**, while both hands are available for palpation. From there, the tape is run along the longitudinal axis of the uterus to the top of the symphysis – a fixed point, and the more easily identified landmark.

Answer 175

If you need to take scalp lactate

Answer 176

**Yuzpe method** (ethinyl estradiol / LNG) * Oldest method, not available in a lot of countries * 2 doses given 12 hours apart * Failure rate = 2-3% * 72 hours * AE = N&V: often simultaneously prescribed with an anti-emetic **Levonorgestrel** (LNG - a progesterone) * Method of choice * Available OTC * Less adverse effects * Failure rate = 1-2% * Can be taken within 72 hours, but preferable within 24 hours **Copper IUD** * Can be taken up to five days post unprotected intercourse * Failure rate = 2-3% * Should not be used in those at risk of STIs or PIDs **Mifepristone (RU486)** * progesterone antagonist * Faiure rate = 1-2% * Few side effects * Can delay menses, which can cause anxiety * Can be used up to five days after unprotected intercourse

Answer 177

That the foetal head is engaged. If it's not, when you rupture the membranes the cord could fall out and then the baby will compress it when it's head enters the pelvis, this could be fatal for the baby!

Answer 178

Transcervical foley catheter

Answer 179

**First Trimester Screening Advnatages** * Earlier - more options in terms of CVS / amniocentesis and more options for TOP? * More sensitive for Trisomy 21 and 18 **Second Trimester Screening Advantges** * Is free (versus first timester which costs money) * AFP protein levels can be used to screen for NTDs (although the 20 week ultrasound is more reliable)

Answer 180

**Good Choices** * Progesterone only pill * Barrier protection * IUDs * Injectable progesterones **Bad Choices** * Breast feeding as exclusive contraception * Combined OCP (as oestrogen affects milk supply) * Tubal ligation

Answer 181

General: * Fatigue * Headaches * Muscle/joint aches Cognitive: * Depression * Memory loss * Difficulty concentrating Vasomotor: * Hot flushes * Night sweats * Urogenital Vaginal dryness/itching * Urinary frequency/urgency

Answer 182

1. miscarriage, ectopic pregnancy 2. placental abruption, placenta previa, vasa previa 3. uterine atony

Answer 183

Hypertonic uterine activity: therapeutic rest with morphine sulfate Hypotonic uterine contractions: IV oxytocin in a continuous infusion increased incrementally; artificial rupture of membranes

Answer 184

3 or more pregnancy losses

Answer 185

* Down syndrome * Ultrasound nuchal translucency * First trimester serum screening - free beta human chorionic gonadotrophin and pregnancy-associated plasma protein A * Chorionic villus sampling (at 12-14 weeks) or amniocentesis (at 15-18 weeks) * New test (not yet covered by the PBS) - free foetal DNA * Cystic fibroris or thalassaemia * CVB or amniocentesis * Neural tube defect * Ultrasound diagnosis

Answer 186

usually a clinical diagnosis (painful PV bleeding) in pregnancy \> 20 weeks +/- symptoms of shock Can perform transvaginal U/S - but wouldn't do so if patient is unstable!

Answer 187

expectant management surgical management medical management Regardless of treatment option, RCOG recommends anti-D for all non-isoimmunised Rhesus negative mothers.

Answer 188

GDM: 0 hours = 5.5 - 7 1 hour = \> 10 2 hours = 8.5 - 11 DM: 0 hours = \> 7 2 hours = \>11

Answer 189

**Expectant** Placental abruption Cord prolapse Maternal infection Foetal infection **Active** Theoretical increased risk of need for instrument delivery or C-section but research shows no increased risk **In practice you usually blend the two by waiting 24 hours after PROM and if labour hasn't started switch to IOL**

Answer 190

Mother can lose large amounts of blood + The bleeding can be concealed (may not have PV bleeding)

Answer 191

Face presentation Bleeding from skull

Answer 192

WATER, WIND, WIZZ, WALK, WOUND, & WEIRD DRUGS ## Footnote ``` WATER = IV site infections WIND = pneumonia ``` WIZZ = UTI WALK = deep vein thrombosis WOUND = surgucal wound infection WEIRD DRUGS = drug induced fever

Answer 193

The head is at the ischial spines (station = 0.)

Answer 194

tachysystole and uterine rupture if previous uterine surgery

Answer 195

Nitrazine paper testing (alkaline amniotic fluid will turn yellow paper blue) Fern slide Amnisure

Answer 196

**HAIL M** ## Footnote Hirsuitism Acne + Apetite Increase / Weight Gain Irregular bleeding Loss of libido Mood swings (Think: progesterone is a hormone of pregnancy)

Answer 197

IBD (CD & UC) Gastroenteritis (Diarrhoea & Vomitting)

Answer 198

The most immediate management Is to place mum in the Trendelenburg position and push the presenting part back into the pelvis.

Answer 199

sOverall, labour should take no longer than 12 hours for primis and 8 hours for multis.

Answer 200

Push and hold the cord back into the pelvis, and put mother into the trendelenberg position

Answer 201

Blood pressure Weight Urine dipstick AUscultation of foetal heart - from 12 weeks onwards Ask about foetal movements - from 18-20 weeks Fundal height measureennts and abdominal palpation - from 24 weeks

Answer 202

18-20 weeks normally

Answer 203

Antenatal Presentation * PV bleeding after 20 weeks (or not!) * Pain (or not!) * CV risk factors * Signs of shock * Tender, woody-hard uterus Perinatal Presentation * CV risk factors * Uterine tachysystole * Blood stained liqor * Signs of shock * Foetal compromise on CTG

Answer 204

**Maternal condition is the priority – it is important not to deliver an unstable patient** * Seizure first aid First aid * Roll into recovery position * O2 8lpm via hudson mask * Mx seizure * 4mg MgSO4 * Treat HTN * Labetelol * Nifedipine * If fits continue * 5-10mg IV diazepam Once the patient is stable: **URGENT DELIVERY IS THE ONLY DEFINITIVE MANAGEMENT**

Answer 205

Forceps and vacuum assisted deliveries account for 11% of deliveries in Australia.

Answer 206

sAnterior low lying placentas may be in the old scar from the previous LUSCS. This is a placenta accreta until proven otherwise and may need very senior care in tertiary settings.

Answer 207

Foetal movements begin to be felt between weeks 15 and 25 They can be masked by an anterior lying placenta

Answer 208

**_The Bishops Score_** Dilation of cervix Lenth of cervix Consistency of cervix Station Position A score of 6-8 is the cut-off (Dilation of the cervix is the most important component) A score greater than 6-8 indicates a favourable cervix A score of less than 6-8 an unfavourable cervix

Answer 209

Low AFI in 50-70% of women (doesn't always happen) If mild oligohydramnios then need to investigate for other causes (cf: causes of oligohydramnios) If major oligohydramnios --\> most likely from PROM

Answer 210

* PV bleeding after 20 weeks especially if associated with: * abnormal lie * high presenting part

Answer 211

HOMESICKL Headache / hypertension Obesity Medications (some anti-convulsants, some ABx) Embolism / Thrombus / Clotting disorders Stroke IHD Cancer (breast, cervical) Kids (nulliparous) and breast feeding Informed consent / Gillick competent (for minors) Liver disorders

Answer 212

1cm/hour during in multiparous women 2cm/hour in nuliparous women

Answer 213

* Hypovolaemic shock – due to a ruptured ectopic * Neurogenic (cervical) shock – products of conception in cervix (causes an increase parasympathetic drive and bradycardia) * Septic shock – miscarriage with infection

Answer 214

hyponatraemia and oedema (because oxytocin is similar in structure to ADH)

Answer 215

* Folic acid * Iron - the developing foetus iron's source for the first 5 to 6 months of life is the mother * Iodine

Answer 216

Breast tendernessMenorrhagiaMigraineNauseaShorter cycle length and a shorter follicular phase

Answer 217

Give antenatal steroids Erythromycin should be given for (250mg po 6 hourly for 10 days) following the diagnosis of PPROM

Answer 218

After the anterior shoulder is delivered

Answer 219

Identifies viability of the foetus Estimates gestation and date of delivery Identifies and characterizes multiple gestation Identifies risk factors for Down Syndrome as part of 1st trimester screening. Identifies major fetal abnormalities like anencephaly

Answer 220

* Foetal distress * Short/inelastic perineum * Shoulder dystocia * Foetal malposition e.g. occipito-posterior * Intrusmental delivery (especially forceps) * Breech delivery * Previous pelvic floor surgery

Answer 221

* Prolonged bradycardia (5 minutes). * Absent baseline variability ( * Sinusoidal pattern. * Complicated variable decelerations with reduced or absent baseline variability. * Late decelerations with reduced or absent baseline variability.

Answer 222

CAMP HI C Section previously (uterine scar à uterine rupture) Act quickly! (need for non-elective C-section) Malpresentation (non-cephalic presentation) Placenta Previa (risk of haemorrhage) High Parity (increased risk of uterine rupture) Infections (active genital herpes, HIV) / IUGR * (IUGR babies are often delivered by C section b/c they don’t have a good enough blood supply to cope with vaginal delivery.

Answer 223

DR C BRaVADO

Answer 224

**HOMESICK** ## Footnote Headache / Hypertension Obesity Medications (some antivirals/ABx) Embolism / Thrombus / Clotting disorders Stroke IHD Cancer (Breast, Endometrial) Kids (ie. parity) / Breastfeeding

Answer 225

with B-HCG Falling levels or failure to rise 50% in 48 hours suggests an abnormal pregnancy.

Answer 226

* Blood group --\> anti-D given to rhesus negative women * B-HCG / U/S to confirm viable, intra-uterine pregnancy * high vaginal swab / serology to rule out chlamydia * culture of genital discharge to rule out gohnorrhea * vaginal swab to rule out bacterial vaginosis

Answer 227

Maternal Serum Screening - 10/40 U/S - 12/40

Answer 228

transvaginal u/s are most reliable when the B-HCG is \>1,500 U/L a transabdominal u/s is most reliable when the B-HCG is \>3,500 U/L

Answer 229

major = covering the os minor = within 2-3 cm of the os

Answer 230

**Placenta Previa** * Painless bleeding * Abdo SNT * Patient not distressed * CTG may be NAD * Abnormal lie / presentation * Not associated with CV risk factors or preeclampsia * Clotting abnormalities unusual **Placental Abruption** * Painful bleeidng * Woody hard uterus * Patient distressed * CTG may be abnormal * Normal lie / presentation * Associated with CV risk factors and preeclampsia * may develop clotting abnormaliites early

Answer 231

Think 1G 3T 4C Gonorrhea Trichomoniasis, Toxoplasmosis, Thyroid function Chlamydia, Hep C, CMV and cervical abnormalities

Answer 232

* **pregnant women from 28 weeks gestation during every pregnancy** * partners of women who are at least 28 weeks pregnant if the partner has not received a pertussis booster in the last ten years * parents/guardians of babies under six months of age and they have not received a pertussis booster in the last ten years.

Answer 233

* FBE * Blood group and antibodies * Consider group and hold * B-HCG - consider serial BHCG (levels may be fluctating) * Transvaginal / abdominal U/S * if the uterus is empty --\> either ectopic por misscarried **NB**: In haemodynamically unstable patients in whom ectopic pregancies are the most likely diagnosis, U/S investiagations can be bypassed for diagnosis and treatment at laparoscopy.

Answer 234

5% of pregnancies have a low lying placenta. Most migrate so only 0.5% of pregnancies end up with placenta previa. Be aware of any vaginal bleeding, and present to hospital immediately. Depending on how much of the cervical os the placenta is covering (and whether the baby is engaged or not), you may have to have a C section, rather than a NVD. In the mean time, avoid penetrative sex and warn any doctors or midwives that you hve placenta previa, as they should not perform a VE if you are bleeding

Answer 235

Basics * education RE: * penetrative sex and VE * what to do if experiences PV bleeding * prognosis Place and Person Ix and Confirm Diagnosis * *Repeat U/S at 34 weeks* * Placenta previa? Major or minor * Make decision about delivery method Definitive Management * Ensure blood is available at delivery Prognosis

Answer 236

GDM Gestational HTN Suspected IUGR (uterus too small) Decreased fetal movements felt (FMF) History of pregnancy loss or complication in late pregnancy

Answer 237

When the cessation of ovarian function occurs before the age of 40 years (ie. cessation of menstruation before age 40)

Answer 238

should double every 48 hours * Too quickly - molar pregnancy.* * A molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus and will fail to come to term. A molar pregnancy is a gestational trophoblastic disease which grows into a mass in the uterus that has swollen chorionic villi. The word mole is used to denote simply a clump of growing tissue, or a growth. It is often caused by a sperm combining with an egg which has lost its DNA). * Too slowly -* non-viable pregnancy: ectopic or miscarriage * Fluctuating B-HCG* - ectopic pregnancy

Answer 239

15-20% of women will experience BEP

Answer 240

1 hour in multigravid women 2 hours in primigravid women 3 hours if having epidural no longer than three hours

Answer 241

Bloody show (a small amount of blood with mucous discharge from the cervix) may precede onset of labor by as much as 72 hours. Bloody show can be differentiated from abnormal 3rd-trimester vaginal bleeding because the amount is small, typically mixed with mucus and the pain due to abruptio placentae is absent. In most pregnant women, previous ultrasonography has been done and ruled out placenta previa. However, if ultrasonography has not ruled out placenta previa and vaginal bleeding occurs, placenta previa is assumed to be present until it is ruled out. Digital vaginal examination is contraindicated, and ultrasonography is done as soon as possible.

Answer 242

Breast Cancer But use with caution and explain all possible risks to patients with "HOMESICKL"

Answer 243

aka the 'quad test' involves only maternal serum screening but screens for four markers (alpha feto protein / AFP, unconjugated estriol, B-HCG and inhibin A)

Answer 244

Term baby Engaged with cephalic presentation NO PV exams CTG normal Mother in a facility able to properly monitor her Maternal vitals normal GBS negative

Answer 245

Polyhydramnios - AFI \>25 Oligohydramnios - AFI

Answer 246

2/3 1/3 of women don't have any PV bleeding! The bleeding is concealed and they are bleeding into their uterus.

Answer 247

at the 20 week scan you can usually see that a woman has a "low lying placenta" If it is low lying, in a lot of cases it will migrate

Answer 248

**Causes** * Perineal pain and ‘after-pain’ (uterine contractions) are common in the first 3 days of peurperium. * It is preferable to avoid opioid analgesia because it can slow resumption of normal bowel function. **Management** * Regular paracetamol * Topical lignocaine * Diclofenac (voltaren) suppositories at birth and 12 hours postpartum (best evidence for perineal pain) * Laxatives to avoid straining on perineal tear

Answer 249

post dates ie. \> 40 weeks

Answer 250

spontaneous pregnancy loss early pregnancy failure

Answer 251

PATH / ROAD Prolapsed umbilical cord Abruption of placenta Tachysystole Hyponatraemia/haemorrhage Rupture of uterus Oedema/fluid retention Atonic uterus Didn't work (failure leading to C section)

Answer 252

5% Follow up ultrasound at 34 weeks, explain to mother that it's like blowing up a baloon so the placenta is likely to move to a safe spot 0.5% go on to have placenta previa

Answer 253

"In term PROM or PPROM, either PGE2 or an oxytocin infusion are acceptable, regardless of cervical status, as they are equally effective"

Answer 254

HR falls below baseline by \>15 bpm for \>15 secs

Answer 255

RWH defines normal as between 5-25, other sources say \>10 **If baby is in REM sleep, variability can be**

Answer 256

* The uterus becomes firm and globular * A gush of blood flows from the vagina * The umbilical cord lengthens outside the vulva * The uterine fundus rises in the abdomen

Answer 257

Maternal * Abnormal pelvic anatomy * Diabetes * Post dates prePnancy * Previous shoulder dystocia * Short stature * Obesity Fetal * Macrosomia * Postmsyutity Intrapartum * Long first stage of labour * Long second stage of labour * Instrumental delivery * Induction of labour * Use of oxytocin

Answer 258

the baby's head must be fixed and engaged, otherwise may --\> cord prolapse

Answer 259

* Apparent or likely foetal compromise in the second stage * Delay in the second stage (\>1 hour for multi, \>2 to primi à epidural ads an extra hour to each) * Maternal effort contraindicated (cannot strain) * Cerebral aneursym * Aortic dissection * Severe HTN

Answer 260

**Higher risk of aspiration** The uterus is pushing up on the abdominal cavity + progesterone relaxes the lower oesophageal sphincter

Answer 261

Yearly in all sexually active young people aged 15–29 years

Answer 262

Maternal infection Neonatal infection Cord prolapse Cord compression Placental abruption ## Footnote **Plus in PPROM additional risk of premature birth**

Answer 263

Two things: 1) In suspected RhD, the flow velocity of the middle cerebral artery can be used to quantify foetal anaemia. This is the equivalent of listening for a flow murmur in an anaemic adult 2) diastolic flow patterns in the umbilical artery can demonstrate high resistance in the placenta vasculature and assess the risk for pre-eclampsia, IUGR and abruption

Answer 264

Only investiagte after 3 miscarriages

Answer 265

* The foetal vertex must be engaged * The position of the foetal vertex myst be certain * Membranes must be ruptured * Uterine contractions must be present * The cervix must be fully dilated * The bladder should be emptied * Adequate anesthesia is optimal

Answer 266

**First**: from the onset of labour to full dilatation (commonly lasts 8-12 hours in a first labour, 3-8 hours in subsequent labours) **Second**: from full dilatation of the cervix to delivery of the baby (commonly lasts 1-2 hours in a first labour, 0.5-1 hour in subsequent labours) **Third**: from delivery of the baby to the delivery of the placenta (commonly lasts up to an hour if physiological, 5-15 minutes if actively managed)

Answer 267

* On initial presentation of patient with contractions * Latent phase: sparingly if membranes have ruptured * Active phase: approximately every 2 hours * If the patient reports the urge to push of FHR decelerates

Answer 268

**CAMP HI** C Section previously (uterine scar --\> uterine rupture) Act quickly! (need for non-elective C-section) Malpresentation (non-cephalic presentation) Placenta Previa (risk of haemorrhage) High Parity (increased risk of uterine rupture) Infections (active genital herpes, HIV)

Answer 269

APH = bleeding after 20 weeks BEP = bleeding before 20 weeks

Answer 270

Slows it down, becaused reduced sensation of need to push Increases time of second stage from 1-2 hours in multigrad, 2-3 hours in primigrad

Women's Flashcards

(321 cards)